Basic Information
| Provider Information | |||||||||
| NPI: | 1366048175 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JARES | ||||||||
| FirstName: | SONA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 672 STANHOPE DR | ||||||||
| Address2: | |||||||||
| City: | CASSELBERRY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327075726 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5650 RED BUG LAKE RD | ||||||||
| Address2: | |||||||||
| City: | WINTER SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327084904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076990781 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2020 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS28232 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.